Concerns About Modesty During Gallbladder Removal Surgery

Doctors may recommend gallbladder removal surgery if you have pain or other symptoms from gallstones or your gallbladder is not working normally (biliary dyskinesia). Gallbladder removal surgery is often done under general anesthesia.

The good news is there are some alternatives to gallbladder removal surgery that you can look into before consenting to surgery. There are some natural treatments that can relieve you of gallstones. Also, changing your diet could help to resolve your gallbladder problems. Do research and check out Gallbladder surgery alternatives.

Procedures for ensuring a patient’s dignity and modesty vary greatly across hospitals for gallbladder removal surgery (also known as cholecystectomy) . Some hospitals demand that you be fully nude under your gown which is unnecessary for gallbladder removal surgery. The chest and abdomen have to be exposed for this type of surgery, but a patient should be allowed to wear surgery shorts and 100% cotton underwear. There is no reason for urinary catheter to be inserted since gallbladder removal surgery only takes 1 hour long. Look under general anesthesia section of Unnecessary Urinary Catheterizations and Lack of Informed Consent. Some medical facilities continue to allow unnecessary urinary catheters to be inserted in gallbladder surgery patients. The other issue is that prior to surgery and then for a period of time after, some patients are heavily sedated leaving them unable to either advocate for themselves or recall what happened or who provided care. For many patients, this is quite disconcerting.

Before you consent to surgery, there are two principles that should guide your discussions with your providers: 1) communicate your all your wishes and concerns to everyone involved in your surgery—even if you think they are obvious and 2) get the agreements you make with your doctor and surgery department at the hospital in writing.

There are three domains around which you should have careful conversations and record all your agreements:

Procedures

Types of gallbladder removal surgery:

a) Laparoscopic gallbladder removal - surgery to remove the gallbladder using a medical device called a laparoscope. This is the most common way to remove the gallbladder. This surgery is done under general anesthesia. Most people go home on the same day or the next day.

• The surgeon will make three to four small cuts in your belly below the breasts.
• The laparoscope will be inserted through one of the cuts.
• Other medical instruments will be inserted through the other cuts.
• Gas will be pumped into your belly to expand it. This gives the surgeon more space to work.
  

b) Open gallbladder removal - surgery to remove the gallbladder that uses an open surgical cut instead of a scope. In open gallbladder removal surgery, a surgeon makes a large surgical cut in your belly to open it up and see the area. The surgeon then removes your gallbladder by reaching in through the cut, separating it from other organs, and gently lifting it out. Surgery is done while you are under general anesthesia . The surgeon will make a 5- to 7-inch cut in the upper right part of your belly, just below your ribs. The surgeon will cut the bile duct and blood vessels that lead to the gallbladder. Then your gallbladder will be removed. This type of surgery takes 1 hour. Most patients with this type of surgery stay in the hospital for 1 to 4 days.

There is no getting around the fact that you will be exposed to a number of people for the procedure if you are a woman and/or if you take off your underwear. It is the job of doctors and their assistants to make you feel as comfortable as possible. In that effort, they are likely to either skip over details of what they will be doing, or they will try to make it sound as clinical as possible. The basic truth is that once you are in the operating room your gown will then be removed because they must have access to your chest and belly for the surgery. If you do not have surgery shorts and/or underwear on under your gown, your genitals will be exposed. If you were anesthetized you will be “awakened” and likely given more sedation, then you will be taken to the PACU where they will care for you.

Male Patients

If a male patient is allowed to keep his shorts and/ or underwear on, there would be no modesty concerns since only his chest and belly would have to be exposed. Male patients still need to take precautions to make sure that their underwear and shorts are never removed and that urinary catheter is not inserted.

Female Patients

For some cases, a woman might be able to wear a specialized bra for this type of surgery. If it is a single site Da Vinci surgery, the Modesty Bra from Modicine PatientWear could be easily worn. If the procedure is a multi-incision laparoscopic surgery, you are advised to get surgeon's approval prior to purchasing the Modesty Bra. A female patient who does not want any men to see her breasts will need to select a female general surgeon, a female anesthesiologist or nurse anesthetist, female scrub technicians, and female nurses depending on type of surgery or can wear the Modesty Bra depending on the type of surgery and surgeon's approval.

The description above is very general and may be different for your doctor or hospital, but the purpose is to give you a frame for asking questions. For example, you might ask if you will be covered while your doctor examines you in the Operating Room or you might ask to be awake for the exam. Also, be sure to ask about the windows in the Operating Room. In some hospitals, there are windows everywhere so that people can watch procedures.

People Who Will Be Involved in Your Medical Care

Patients rarely consider the fact that there are a number of people in and out of an Operating Room before and during a surgery. Your doctor will have an assistant to help with the procedure. Generally the doctor selects his/her assistant. The hospital will assign several medical personnel for the operation including nurses, anesthesiologist or nurse anesthetist, surgical scrub technicians, and a scrub/circulating nurse. The job of a scrub / circulating nurse is to make sure all the tools are ready for the doctor, bring you into the OR, prep your body for surgery, and record information about your preparation. Generally, you only meet anesthesiologist or nurse anesthetist just before the surgery. There will also likely be 2 other surgical scrub technicians involved. Their job is to bring things to the scrub nurse, doctors or assistants, clean up discarded items and assist in any other way they are asked. You should be aware that nurses can take breaks in the middle of surgeries. When this happens, a team comes in to relieve them. This means that they could bring in male nurses to replace the female nurses during their breaks and this is a concern for female patients whose breasts will be exposed.

Some hospitals allow medical students to participate in gallbladder removal surgeries. Keep in mind that some hospitals especially teaching hospitals still allow medical students to practice genital, pelvic, and rectal exams on surgery patients without their consent. See more information on non-consensual genital and pelvic exams.

Questions you might consider are:

1.) Who is going to assist the surgeon? Do not assume you know this. A doctor will often have someone in her office that does most of the surgeries with her/him. If that person is unavailable, the doctor will call someone else and usually not bother to tell you unless you ask. If you want to have an all-female team, you must tell her that you only accept a female assistant.

2.) Who will the scrub/ circulating nurse going be?

3.) Who will be the anesthesiologist?

4.) Who will be the surgical scrub technicians?

5.) Who will be the PACU nurse?

6.) Is there any chance that medical students will be present? If so, what role will they play?

7.) Can someone such as my husband, friend, or family member be present with me for the surgery?

8.) Is there any chance that someone else such as an equipment representative, hospital quality assurance person or medical device representative will be in the operating room? If so, you may refuse consent for such people.

9.) Is there any chance that any of the nurses could take breaks during my surgery and be replaced with other nurses?

Drugs

This is the area that perhaps is the most ignored by patients. Many patients genuinely do not want to know what is happening and want to be sedated for as long as possible—that is absolutely their right. However, if you wish to be aware of what is happening, you need to make your wishes clear to your doctor and thoroughly ask your anesthesiologist or nurse anesthetist about his/her plan.

First of all, be aware that “awake” to a doctor is different than “awake” to a layperson. Patients are often given Versed or other sedatives prior to entering the Operating Room to alleviate stress and help you to relax. While Versed is an anti-anxiety medication, it also has a powerful amnesia effect. It can have other lasting effects, including effects on behavior and memory for months or years afterwards. Versed is also known as a date-rape drug. It is used to make a person compliant and induces conscious sedation. It causes a person to not remember. It's a dangerous drug which is not in the best interest of patients. Many patients will not be able to remember anything while under its influence. If you’re given Versed prior to being brought into the Operating Room, you will likely not remember who is in the room, being placed on the OR table or being prepared for anesthesia. So while the doctor may say you will be “awake,” be sure to clarify what that means. Further, once surgery is over, you will likely be give few more doses of Versed, again that means you will likely not remember being in the PACU.

You should not consent to Versed because you are no longer able to advocate for yourself once you are given Versed because it causes you to have a powerful amnesia effect. Versed gives medical personnel the opportunities to do many things without your consent. Versed also legally invalidates any patient testimony regarding their treatment.

There is no reason for you to be given Versed. You should write on your consent form that you do not give consent for Versed to be administered at all. There may be other benzodiazepines that can substitute for Versed. Also, Versed is a brand name for Midazolam. If somebody just refuses “Versed”, they can still give them the generic. To play it safe, mention that you do not consent to Versed, Midazolam, or any other benzodiazepine.

All three of these areas are vital to your care and your concerns about modesty. Remember that a conversation is not enough. Once you have come to an agreement with your doctor about the issues above, you need to be sure that you write those directives on your consent form.

Important Tips For Patients Concerned About Modesty During Cholecystectomy:

1.) You should write a list of expectations that you and your doctor sign. Make several copies of the list. Then when you sign your hospital consent forms and any other form you are asked to sign, note by your signature that you have a list of expectations that are attached and have the person witnessing your signature initial that note.

Your list of expectations should be clear and direct. For example:

• I withhold consent for any sedation until after I have been brought to the OR.
  
  
• Women - I withhold consent for any male medical personnel or medical students being present during my surgery or observing my surgery.
  
  
• Women - If my wishes cannot be accommodated for an all-female team, the surgery must be cancelled or postponed.
  
  
• I withhold consent for a urinary catheter.
  
  
• I withhold consent for genital, pelvic, and rectal exams.
  
  
• My underwear and shorts may not be removed at all.
  
• My bra may not be removed at all.
  
  

2.) Try to get all consent forms prior to the day of surgery and read them carefully. Write in any changes or requests

3.) Visit the hospital you will be having the surgery at and ask to speak to the nursing supervisor and/or manager of the surgery dept. Discuss your wishes about who you want to be present. If you are a woman, make sure you indicate if you don't wish for even female medical students to be there. Some women who want an all-female team are open to female medical students observing their surgery.

4.) Insist that they do not give you an IV until you have been prepped for surgery.

5.) It is prudent to have an advocate not employed by the hospital such as your husband present the whole time for pre-op, surgery, and post-op to make sure that your wishes are honored. This is the only way you can have a guarantee that your wishes will be honored. Remember that someone else could come in middle of your surgery including a sales representative, a janitor, or other nurses. Check out Why You Should Have a Personal Advocate For Surgery?

6.) Walk out and cancel the surgery if you see that your wishes will not be honored for an all-female medical team (if you are a woman) or other requests such as leaving underwear on. Patients need to stand up to show medical professionals that they are not willing to compromise.

7.) Find another doctor if she/he is not willing to work to accommodate your wishes.

8.) Find another medical facility if they are not willing to work to accommodate your wishes.

Female surgeons are much harder to find than female gynecologists. You usually can find several female general surgeons in big cities. This is a big challenge for women who may live 200 miles or more away from a big city. You may have to travel a long distance, but it is worth it.

Other Related Articles:

Gallbladder Surgery Alternatives

Tips For Female Patients To Prevent Sexual Abuse In Medical Settings

Do Chaperones Really Protect Patients?

What You Should Know About Sedation and Versed?

Sources:

Gallbladder removal - laparoscopic

Gallbladder removal - open

Laparoscopic Gallbladder Surgery for Gallstones